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The Appointment - a film to support working towards dementia friendly dental practices

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The Appointment: a film to support working towards dementia friendly dental practices - presentation at the Faculty of Public Health annual conference 2016

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The Appointment - a film to support working towards dementia friendly dental practices

  1. 1. The Appointment a film to support working towards dementia friendly dental practices Katy Kerr MSc BDS DDPH RCS(Eng) PGCertCE Regional Dental Advisor HEETV/W
  2. 2. • Key public health drivers behind the project • Explore why oral health is important, especially for a person with dementia • Watch the film “The Appointment” • Dementia awareness in general dental practice • Ways to promote good oral health and help carers with mouth care Aims @NHS_HealthEdEng
  3. 3. • Cost of poor oral health • Dental diseases are preventable • Impact of disease on treatment outcomes • Core standards and quality of care • Complaints/ safeguarding • Common risk factors Key drivers for change @NHS_HealthEdEng
  4. 4. Poor dental health costs the NHS £3.4 billion a year compared with £4.7 billion for excess body weight PHE Sugar reduction: responding to the challenge. June 2014 Dental diseases are expensive @NHS_HealthEdEng
  5. 5. Dental diseases are preventable • Effective daily mouth care using correct products • Person centred approach • Dietary considerations @NHS_HealthEdEng
  6. 6. Oral health affects quality of life • Direct effects e.g. dental pain, missing teeth, Xerostomia (dry mouth) • Impacts on eating, sleep, rest and social roles • Oral disease can increase risk of systemic disease @NHS_HealthEdEng
  7. 7. “Dementia costs the UK economy £17 billion a year.” Living well with dementia: A National Dementia Strategy (Department of Health 2009) The resident population of England and Wales in 2011 was 56.1 million One in six people were aged 65 or over (16 per cent = 9.2 million) 2011 Census England and Wales @NHS_HealthEdEng
  8. 8. Poor oral health for older people • Painful teeth, ulceration and mouth infections • Dry mouth • Ill fitting or lost dentures • Increased risk of dental disease @NHS_HealthEdEng Demonstrated association between bacteria in the mouth and aspiration pneumonia
  9. 9. • Change in oral health could be early sign of memory loss • They experience higher levels of untreated disease and it is more difficult to access dental care • Both pain and infection can decrease cognitive function Oral health in dementia patients @NHS_HealthEdEng
  10. 10. The Appointment Film available (free) on YouTube or from HEETV Dental School website @NHS_HealthEdEng This video is based on an established collection of dementia awareness DVDs called “Barbara’s Story” originally produced by Guys & St Thomas’s NHS Foundation Trust and White Boat TV Resource pack available for reflective learning
  11. 11. To raise awareness regarding the issues that affect provision of dental services for an individual with dementia • Increase knowledge about dementia including identifying the early stages • To consider how oral care may be delivered • To gain insight into challenging behaviour and to be compassionate whilst caring for patients with dementia • To maintain the dignity of the individual at all times The film aims:- To support patients with dementia to live well @NHS_HealthEdEng
  12. 12.
  13. 13. • What have you learned from watching this film? • How may your practice now change? • What other actions may you take? • Have any training/ further learning needs been identified? @NHS_HealthEdEng Watch together as a team Reflective learning
  14. 14. • Promote effective communication in the dental practice to enable supporting people with dementia • It can be stressful to treat people with dementia so it is also important to build supportive relationships within the team so that issues can be raised and problems shared Use a whole team approach @NHS_HealthEdEng
  15. 15. Dementia Friendly Communities The Alzheimer’s Society have a vision to empower people with dementia to have high aspirations, confidence and know they can contribute
  16. 16. How dementia friendly is your dental practice? • Dementia champion • Training • Audit using ISPACE • Action plan • Date for review @NHS_HealthEdEng (Wessex Academic Health Science Network). = Accreditation
  17. 17. • Carers can help the person by providing company, assistance and help with communication during a dental visit • Maintaining oral hygiene if the person with dementia is no longer able to do this. Importance of Carers @NHS_HealthEdEng
  18. 18. What’s the problem? @NHS_HealthEdEng Oral hygiene 48% Safe staffing for older people’s wards 2012 Nurses reporting that activity was left undone, or was done inadequately on their last shift due to lack of time
  19. 19. Care-resistive behaviour •Refusal, not opening mouth •Needing prompting •Not understanding caregivers' instructions •Not able to rinse or spit •Biting toothbrush or caregiver •Physical/verbal aggression •Not permitting removal/insertion of dentures Chalmers et al (2008) Spec Care Dentistry @NHS_HealthEdEng
  20. 20. Patient compliance • Motivation • Behaviour • Cognitive ability • Dexterity • Anxieties • Sensory perception • Consent @NHS_HealthEdEng Depends on:-
  21. 21. • Identifying who is responsible • Not using an assessment • Not having a routine for mouth care and the correct products • Poor patient compliance • Staff perceive that mouth care is not a high priority • Other health issues prevent oral care Common issues @NHS_HealthEdEng
  22. 22. Products available • Pink sponges/ lemon and glycerine swabs • Water • Toothbrush with a large head • Strong tasting, foaming toothpaste @NHS_HealthEdEng
  23. 23. • CQC registered Nursing homes must have Registered Nurse and witness if Medication(s) are dispensed. • Nurses are responsible for writing care plans • Nurses can influence other care givers and ensure mouth care is carried out Important to train nurses @NHS_HealthEdEng
  24. 24. An e-learning package to support the training of all healthcare professionals involved in mouth care Three levels: • Introduction to mouth care • Mouth care for Adults • Mouth care for people with additional needs Improving mouth care @NHS_HealthEdEng Interactive Video links Further reading and practical exercises PDFs of paperwork Scenarios (Developed in consultation with staff involved in the pre-registration nurse training and piloted by students in Oxford Brookes, Southampton General and the John Radcliffe)
  25. 25. Content • Evidenced based mouth care- for natural teeth and dentures • Checking the mouth • Assessment, care plans and documenting care • Products • Addressing common problems • Strategies when oral care is difficult Dementia care threaded through all the modules @NHS_HealthEdEng
  26. 26. CHIN C • Check H • Help I • Inform N • Note @NHS_HealthEdEng
  27. 27. A clean mouth is essential @NHS_HealthEdEng People may need help How to offer support Addressing specific problems
  28. 28. Dementia care
  29. 29. • Formalising scheme for dementia friendly dental practice • Raising the profile of oral health and influencing the care provided, including correct products • Making training more widely available in mouth care • Promoting the use of assessments and the inclusion of mouth care in care plans so that we ensure patients are receiving the correct advice and assistance • Ensuring mouth care recorded in documentation Currently working to promote @NHS_HealthEdEng
  30. 30. Lots more work to be done …. • Oral health included in dementia strategies, policies, guidance • Oral health becomes integral part of health risk assessment in care homes and hospitals • Commissioning and funding for access to dementia friendly dental care within suitable environments and domiciliary visits when appropriate • Robust referral and integrated care pathways to appropriate local specialist dental care @NHS_HealthEdEng
  31. 31. E-learning modules available on E-Learning for Health Thank you for listening Improving Mouth Care Any questions? @NHS_HealthEdEng Katy Kerr